Today we have a 5th notification, involving a 31 year old woman hospitalized in Futian, Shenzhen, published by neighboringHong Kong's CHP.Given Guangdong Province's close proximity to, and trade relations with, Hong Kong - they tend to be more willing to share timely avian flu reports than do other Provinces.

First the Hong Kong Notification, then I'll have a bit more.

CHP notified of additional human case of avian influenza A(H5N6) in Guangdong
The Centre for Health Protection (CHP) of the Department of
Health (DH) was notified of an additional human case of avian influenza
A(H5N6) in Guangdong by the National Health and Family Planning
Commission today (January 18), and again urged the public to maintain
strict personal, food and environmental hygiene both locally and during
travel.

The case involves a woman aged 31 in Futian,
Shenzhen. She developed fever and cough on January 8 and is currently
hospitalised for treatment in critical condition.

From 2014
to date, a total of nine human cases of avian influenza A(H5N6) have
been reported by the Mainland health authorities.

"All novel
influenza A infections, including H5N6, are statutory notifiable
infectious diseases in Hong Kong," a spokesman for the CHP said.

"We
will remain vigilant and work closely with the World Health
Organization and relevant health authorities to monitor the latest
developments," the spokesman said.

Although it has yet to have as big of impact as avian H7N9, the recently (2014) emerged H5N6
virus - a reassortant of H5N1 and H6N6 - has generated a good deal of concern as
it has infected a small, but growing number of humans over the past 20 months.

The
extensive migration routes of wild birds may contribute to the
geographic spread of H5N6 AIVs and pose a risk to humans and susceptible
domesticated animals, and the H5N6 AIVs may spread from southern China
to northern China by wild birds. Additional surveillance is required to
better understand the threat of zoonotic transmission of AIVs.

While details have been scant, we've seen nothing to suggest any of these five cases are epidemiologically related, or that the virus is circulating in the human population.

Five cases in such a short period of time, however, does suggest the virus is getting better established in poultry populations and the environment.

It has already turned up in wild and migratory birds in Hong Kong (seeHong Kong: Magpie Robin Tests Positive For HPAI H5)several times. Given the lack of wild bird surveillance and reporting out of Mainland China, we don't really have a good feel for how rapidly the virus might be spreading.

While
H7N9 and H5N1 have been the most worrisome avian flu viruses to
date, H5N6 is showing signs of becoming a contender, and is definitely a
virus to watch.